Percentage of patients aged 3 through 17 years of age, who undergo general anesthesia in which an inhalational anesthetic is used for maintenance AND who have one or more risk factors for post-operative vomiting (POV), who receive combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively and/or intraoperatively.
The purpose of this process of care measure is to reduce the incidence of postoperative nausea and vomiting in pediatric patients.
Postoperative nausea and vomiting (PONV) is a common and unpleasant outcome of anesthesia care that can lead to other complications, lengthening the patient’s recovery period after surgery2. Effective management of PONV leads to optimal patient outcomes and comfort during the postoperative period.3 Combination therapy that includes two prophylactic pharmacologic anti-emetic agents of different classes is most effective when managing PONV in children.4,5
A separate PONV risk model should be considered for pediatric patients as many proven risk factors for adults are difficult to assess or do not apply to children.6 The independent PONV risk factors identified for pediatrics include duration of surgery greater than 30 minutes, age greater than 3 years old, positive history of PONV (individual and/or immediate family) and strabismus surgery.6 Although including a prophylactic anti-emetic administration protocol that considers such risk factors has shown to reduce the incidence of PONV, there is high variability in this outcome.7,8
4 hours before Anesthesia Start to PACU Start
All patients, age 3 through 17 years of age, who undergo any procedure under general anesthesia in which an inhalational anesthetic is used for maintenance AND who have one or more additional risk factors for POV.
POV Risk Factors:
Patient receives combination therapy consisting of at least two prophylactic pharmacologic anti-emetic agents of different classes preoperatively or intraoperatively
Anti-emetic therapy: The recommended pharmacologic anti-emetics for PONV prophylaxis in pediatric patients at risk for moderate to severe PONV include (but may not limited to):
Note: In addition, propofol infusion is accepted as one of the antiemetic options for this measure. The foregoing list of medications/drug names is based on clinical guidelines and other evidence. The specified drugs were selected based on the strength of evidence for their clinical effectiveness. This list of selected drugs may not be current. Physicians and other health care professionals should refer to the FDA’s web site page entitled “Drug Safety Communications” for up-to-date drug recall and alert information when prescribing medications.
For a case to be included for the PONV 02 measure, the patient must have received inhalational general anesthetic for maintenance purposes AND have two or more risk factors for POV. This measure determines maintenance using the Halogenated Gases Used and Nitrous Oxide Used phenotypes and must return value code > 1.
Values for flows and gases will be assessed and considered artifact if less than the following ranges and the patient did not receive any other inhalational general anesthetics greater than these ranges:
Provider(s) signed in at Induction End.
Method for determining Responsible Provider:
Class: 5-Hydroxytryptamine (5-HT3) Receptor Antagonists
Neurokinin-1 Receptor Agonists
PONV Medical Reason Exclusion
PONV Risk Factor- History of PONV/Motion Sickness:
|Date Reviewed||Reviewer||Institution||Summary||QC Vote|
Inhlational general defined with new Nitrous and Halogenated gas phenotypes
Strabismus exclusion uses Strabismus phenotype
Surgery duration uses Case duration phenotype
Modified Measure Start, - 4 hours before Anesthesia Start
Modified Measure End, PACU Start
Labor Epidural exclusion now uses Obstetric phenotype
|04/20/2022||Inclusion||Updated inhalational gas threshold values|
|08/04/2020||Success||Modified to use note entered time if observed time is not available|
|01/22/2020||Inclusion||Added time bounds for receiving general anesthetic|
|09/30/2019||Exclusion||Added 'Transported to ICU' as exclusion|